Medical Development

CAREER SUMMARY/GOALS

Experienced professional with a Masters degree in health administration and a diverse background in medical staff administration/governance, program development, compliance/accreditation, and development and implementation of centralized credentials verification organizations, and accredited continuing medical education programs. Future goals are the development and expansion of my skills and knowledge, and the opportunity to teach others from my experiences.

EDUCATION

Masters of Health Administration, 1996, Lindenwood University, St. Louis, Missouri

Bachelors of Science in Human Services, 1994, Southern Illinois University, Edwardsville, Illinois

PROFESSIONAL EXPERIENCE

ADVANCED IN-HOME RESPIRATORY 24, LLC (dba Air 24), Fairview Heights, IL

Independent Contractor (2010 - )

• Prepare start-up DME organization for compliance and accreditation with HQAA, State of Illinois, and CMS requirements.

• Hiring, training and monitoring of RT’s and billing coordinator with ongoing evaluations through competency and performance evaluations.

• Development of company Performance Improvement Plan, Safety Program and annual training programs.

• Development and implementation of organizational policies/procedures and performance monitoring processes.

• Recommendations to the owners/leadership for actions appropriate to bring the organization up to current business and regulatory standards.

• Implementation and maintenance of confidential patient, client, and billing databases and relative reporting systems.

KAPLAN UNIVERSITY, Chicago, Illinois

Adjunct Faculty (2010 - )

• Teaching online sophomore level undergraduate course in Healthcare Management, specifically Understanding Health Insurance: Billing and Reimbursement.

DEVRY UNIVERSITY, Chicago, Illinois

Adjunct Faculty (2009 - )

• Teaching online senior level undergraduate courses in Healthcare Services, specifically Healthcare Services Planning and Marketing.

REHAB CARE GROUP, Inc., St. Louis, Missouri

(Company merger/acquisition 2010)

Director of Corporate Credentialing (2008 - 2010)

• Development of a corporate-wide centralized credentials verification organization.

• Standardization and monitoring of medical staff governance processes and documents across the organization ensuring compliance with all pertinent regulatory agencies and accreditation bodies.

• Enhanced the effectiveness of divisional medical staff service functions across 13 facilities through the implementation of standardized and centralized functions and corporate-wide medical staff demographic and quality databases.

• Hiring, training, supervision and monitoring of departmental staff and training, monitoring and indirect supervision of field staff across multiple states.

• Assume direct management for any facility medical staff services department not performing to standard, and implementing any necessary changes for the facility to become compliant with company policy/procedure, including the retraining or replacement of staff.

Resume

MJ Sexton-Tosh, MSA

Page Two

• Member of corporate compliance team charged with responsibility for governance, medical staff functions and quality management.

• Recommendations to facility and corporate executive committees regarding changes to site policies, procedures and processes as deemed necessary to improve operational efficiencies, effectiveness and performance, and maintain compliance with applicable regulatory bodies.

NATIONAL HOSPICE MANAGEMENT, INC., St. Louis, Missouri

Company closure.

Director of Education and Staff Development (Jan. – Oct. 2006)

• Development of a not-for-profit continuing education foundation with the goal of national accreditation

• Development and provision of training and educational programs relevant to accreditation and regulatory compliance.

• Development of policies and procedures to ensure ongoing compliance and compliance reviews.

CAREER/EDUCATIONAL DEVELOPMENT, Belleville, Illinois

Healthcare Administration Doctorate Program (2006 – 2008)

• Completion of course work for Healthcare Administration doctoral program.

SUMMERLIN HOSPITAL MEDICAL CENTER, Las Vegas, Nevada

Resignation and relocation for family and professional reasons.

Director of Medical Staff Services (1999 – 2005)

• Development of a start-up centralized credentials verification organization uniting the credentialing functions of four sister facilities

• Ongoing working relationships with organization leadership through participation in hospital/medical executive and department committee meetings and the ability to work collaboratively with various cross-level functions of the organization as well as client contacts and business associates

• Development and implementation of policies/procedures, bylaws and rules/regulations to monitor and maintain ongoing compliance with all relative accreditation and regulatory requirements

• Development and implementation of a medical quality management/peer review programs, and demonstrated abilities working with confidential and sensitive information and files.

• Development and management of a not-for-profit medical staff educational foundation and a State accredited continuing medical education program

Professional Affiliations

• National Association of Health Care Quality (1992 - 2003)

• National Association for Medical Staff Services (1993 - )

• American College of Healthcare Executives (2003 - )

Professional Certifications

• Preparation to sit for the NAMSS designation of Certified Professional Medical Staff Management (CPMSM), March, 2011

References

Available upon request.

KEY WORDS

Director, master’s degree, healthcare administration, compliance, accreditation, medical staff services, governance, centralized credentials verification organizations, project development, continuing medical education, CME, peer review, quality management, credentialing, recredentialing, FPPE/OPPE, medical staff committees, corporate compliance, fair hearings, JCAHO.

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